Tuesday, June 10, 2014

Spokane VA center faces "further review" over wait lists

Newly released audit figures from the Department of Veterans Affairs show nearly 1,600 local patients remain on waiting lists at Mann-Grandstaff VA Medical Center in Spokane because they cannot be scheduled for appointments in the next three months — more than the number of similar patients waiting at Seattle's VA Puget Sound facilities, which handle three times as many appointments.

VA officials report more than 57,000 veterans remain on wait lists nationwide as the department reacts to public outrage over widespread treatment delays and scheduling fraud that may have resulted in patient deaths. Investigators recently interviewed more than 3,772 VA employees at 731 facilities across the country, finding 13 percent of staff had been instructed to manipulate appointment dates.

“This behavior runs counter to VA’s core values," the national audit report states. "The overarching environment and culture which allowed this state of practice to take root must be confronted head-on. … It must also be confronted in order to regain the trust of the Veterans that VA serves.”

The audit report, released Monday, lists Spokane as one of the 112 VA facilities requiring "further review" of scheduling practices and care performance. Overall, the Spokane center's wait time averaged just 1.26 days for established patients and 28.55 days for new patients, comparable to other centers, but it's unclear whether those times factor in the 1,593 patients on the local wait list. See the regional report.

Audit records show 412 Spokane patients who have spent more than 120 days on the local "Electronic Wait List," which tracks appointment delays. National records list just five medical centers with more patients who have waited that long.

Spokane also had by far the longest regional wait time for providing mental health services to established patients, averaging a six-day wait for appointments. New patients wait about 27 days for appointments.

Those wait times appear to be reflected in a separate VA performance database, called the Strategic Analytics for Improvement and Learning, which tracks patient outcomes by hospital. The Spokane center fell below national averages on mental health waiting periods.

The SAIL database also states Mann-Grandstaff reports one of the highest “acute care” 30-day mortality rates in the country.

Much of the national criticism of the VA system stems from allegations that officials with the Phoenix VA Hospital may have manipulated appointment schedules to hide treatment delays linked to patient deaths. The director of the Phoenix hospital, Sharon Helman, previously managed the Spokane center from 2008 to 2010.

In 2012, VA investigators determined routine confusion or miscommunication led to treatment delays or canceled consultations at the Spokane center. Findings included several cases in which delays “did result in the adverse patient outcome of increased or unrelieved pain or an exacerbation of symptoms.”

Spokane officials pledged to strengthen policies and increase training in the wake of those findings.

The Inlander sent Spokane VA officials several questions Monday morning regarding the new audit findings, but while officials acknowledged receipt of the questions, they have not yet provided any answers. Spokane VA spokesman Bret Bowers recently defended the center's care practices in an email, saying staff work to comply with national guidelines on timely care.

"The Mann-Grandstaff VA Medical Center would like to recognize and thank all Veterans for their service," he wrote. "VA's mission of taking care of America's Veterans is something all employees and volunteers take very seriously."

UPDATE: Spokane VA officials responded to questions late this afternoon, acknowledging that specialized care demands and staff vacancies have in some cases led to “longer-than-average wait times.” Officials issued an email statement emphasizing the local center’s dedication to providing quality care and outlining steps to improve local mental health services.

“We care deeply for our Veterans,” local VA officials state, “and our intent is to provide timely access to the quality of care our Veterans have earned and deserve.”

VA officials report they recently hired three new psychiatrists, and plan to bring on four more soon. Two temporary psychiatrists have helped address the recent appointment backlog. The center also reports setting up referrals to other area mental health providers if necessary, along with tele-health video consultations.

The Spokane center reports it has hired additional primary care physicians and expanded Saturday appointments. The center also offers 24/7 urgent care through its Emergency Room.

Local VA officials indicated they were not aware of any specific audit findings that led to the call for “further review,” but pledged to fully “cooperate or assist in any investigation and follow up with appropriate actions.”

“Healthcare is dynamic and the data changes frequently,” officials state. “Today’s data reflects the challenges we face, and we are committed to addressing them in a definitive manner.”